Background and aimS Eosinophilic esophagitis (EoE) is an ever growing clinical-pathological condition that generates great morbility and in which symptom control still presents itself as a challenge, having a variety of therapies described throughout the medical literature. The aim of this study is to review the cases handled by our unit in a 6 year period.
Methods Retrospective descriptive unicentric study which analyses clinic, diagnostic methods, indirect disease markers, allergy tests and therapy employed in patients diagnosed with EoE between january 2008 and december 2014. Diagnosis was established with>15 eosinophils (Eos) per high power field (HPF) in esophageal epitelium associated to unresponsiveness to exclusive antiacid treatment.
Results Data from 29 patients was collected, 75.9% male. Mean clinical debut age was 9.1±3.6 years, with a 0.4 years-delay to diagnostic (IQR 0.2–1) and follow-up time of 3 years (IQR 1.9–4). History of allergies was present in 31%. Sensitisation to food allergens was found in 44.7% of the patients, whilst 27.6% were sensitised to pneumoallergens. Various histological alterations were found, 2 of them with pronounced collagenation of the lamina propria in the whole length of the oesophagus, and 1 which presented simultaneous waves and incomplete relaxation of the lower esophageal sphincter in the manometry.
Concerning treatment, 13.8% were on exclusion diet, 3.8% used elemental formulas and 37.9% carried out both simultaneously. Montelukast was employed in 27.6%, proton pump inhibitors in 41.4%, viscous oral budesonide (VOB) in 31%, swallowed fluticasone in 3,4%, whilst systemic steroids were used in 13.8%. Only 1 patient presented stenosis, and one other esophagical motor dysfunction.
ConclutionS It is worth highlighting male genre, dysphagia and history of food impaction, together with history of allergy and food sensitisation. Being the disease’s natural history still unkown, doubts arise concerning the clinical handling of these patients: wether to treat symptoms alone or to persue reversion of the changes in the mucosa to prevent complications such as stenosis. Esophageal samples must have enough lamina propria and a follow-up must be made in order to find relation between remodelling and motor dysphunction in adulthood. New therapies such as topic corticoids as viscous oral budesonide, are useful. It is important to prospectively analyse the efectiveness of this therapy for long-term symptom control.
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